Department of Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
Department of Anaesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Biomed Res Int. 2018 Nov 15;2018:3891870. doi: 10.1155/2018/3891870. eCollection 2018.
The aim of the study was to determine the usefulness of tranexamic acid (TXA) in revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA). We analyzed the perioperative blood loss with and without TXA in aseptic rTHA and rTKA as well as in second-stage reimplantation for hip and knee periprosthetic infection.
In this prospective cohort study, 147 patients receiving TXA (96 rTHA, 51 rTKA) were compared to a retrospective cohort of 155 patients without TXA (103 rTHA, 52 rTKA). The TXA regimen consisted of a preoperative bolus of 10 mg/kg bodyweight (BW) TXA plus 1 mg/kgBW/h perioperatively. Given blood products were documented and the perioperative blood loss was calculated. Thromboembolic events were registered until three months postoperatively. In subgroups, the effects of TXA were separately analyzed in 215 aseptic revisions as well as in 87 reimplantations in two-stage revisions for periprosthetic infection.
Both TXA groups showed a significantly reduced mean blood loss compared to the respective control groups. The TXA group of rTHA patients had a mean blood loss of 2916 ml ± 1226 ml versus 3611 ml ± 1474 ml in the control group (p<.001). For the TXA group of rTKA patients, mean calculated blood loss was 2756 ml ± 975 ml compared to 3441 ml ± 1100 ml in the control group (p=.0012). A significantly reduced blood loss was also found in the TXA subgroups for aseptic and septic revision procedures. No thromboembolic events were recorded among the TXA groups.
There is a significant reduction of perioperative blood loss under TXA influence without an increased incidence of adverse events. The standard use of TXA can be recommended in aseptic hip and knee revision arthroplasties as well as in second-stage reimplantations for periprosthetic infection.
本研究旨在探讨氨甲环酸（TXA）在翻修全髋关节置换术（rTHA）和翻修全膝关节置换术（rTKA）中的应用价值。我们分析了在无菌性 rTHA 和 rTKA 以及髋关节和膝关节假体周围感染二期再植入术中使用和不使用 TXA 的围手术期失血情况。
在这项前瞻性队列研究中，我们将 147 例使用 TXA（96 例 rTHA，51 例 rTKA）的患者与未使用 TXA 的 155 例患者（103 例 rTHA，52 例 rTKA）进行了比较。TXA 方案包括术前 10mg/kg 体重（BW）TXA 静脉推注，术中及术后 1mg/kgBW/h 静脉滴注。记录输注的血液制品并计算围手术期失血。血栓栓塞事件直到术后三个月。在亚组中，我们分别分析了 215 例无菌翻修和 87 例二期翻修治疗假体周围感染中 TXA 的效果。
TXA 组与相应对照组相比，平均失血量均显著减少。rTHA 患者的 TXA 组平均失血量为 2916ml±1226ml，对照组为 3611ml±1474ml（p<.001）。rTKA 患者的 TXA 组平均计算失血量为 2756ml±975ml，对照组为 3441ml±1100ml（p=.0012）。在无菌和感染性翻修手术的 TXA 亚组中，也发现了失血量的显著减少。在 TXA 组中未记录到血栓栓塞事件。
在 TXA 作用下，围手术期出血量显著减少，不良事件发生率无增加。TXA 可在无菌髋关节和膝关节翻修以及假体周围感染二期再植入术中常规使用。
